Could the incidence of postoperative urinary tract infection be reduced byreversing the sequence of vaginal cleansing and urethral catheterization?

Postoperative urinary tract infection (UTI) is a common hospital infection after gynaecological operations. A prospective randomized study was perform ed to examine whether the incidence of UTI could be reduced by reversing th e sequence of vaginal cleansing and urethral catheterization. Subjects were randomly allocated to: (1) urethral catheterization before vaginal cleansi ng; and (2) urethral catheterization after vaginal cleansing. Urine culture s were performed immediately after the procedures as the baseline, on the d ay of catheter removal, and two days after catheter removal. Patients were examined daily after the operation for any urinary symptoms and fever. The incidences of preoperative asymptomatic bacteriuria were similar in both gr oups, seven of 84 in group 1 vs. eight of 83 in group 2. Among those with n egative urine culture before the operation, 77 in group 1 and 75 in group 2 , there was no significant difference in postoperative bacteriuria at cathe ter removal (23 vs. 22) and two days later (35 vs. 42). No significant diff erence was noted in the incidence of UTI (5 vs. 10, P=0.25), with a trend t owards less UTI in group 1. Voiding discomfort was more common, and fever l ess common in group 1. There were significant associations between urine cu lture results at three different occasions. Bacteriuria at catheter removal is associated with a 7.2 times risk of bacteriuria two days later, 2.4 tim es risk of urinary symptoms and 3.2 times risk of UTI. Routine surveillance at catheter removal is not cost-effective. We conclude that postoperative bacteriuria and UTI are common. Reversing th e sequence of the procedures cannot reduce the incidence. There is no evide nce to change the status quo. (C) 2000 The Hospital Infection Society.